Ivabradine in Prevention of POAF after CABG surgery - Trial PACTR202103543569729

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Summary

Atrial fibrillation (AF) is the most common arrhythmia after cardiac surgery; it occurs in 5-40% of patients after coronary artery bypass grafting (CABG). Postoperative new onset AF is associated with increased risk of stroke, in-hospital and 6‐month mortality, and longer hospital stay, compared with populations with no new onset AF. The frequency of postoperative atrial fibrillation has increased over years despite recent developments in cardiac surgical techniques, anaesthetic management and myocardial protection. The exact mechanism underlying postoperative AF is still unclear. Evidence suggests initiation of AF by ectopic beats originating from the pulmonary veins. A recent study demonstrated that fast-pacemaker cardiomyocytes in the pulmonary veins have a larger Funny channels (If) current density than slow-pacemaker ones. Ivabradine (Procoralan®) reduces heart rate by selectively inhibiting If current in the sinoatrial node pacemaker cells, in a dose-dependent manner. This agent has been originally approved for treating stable coronary artery disease, left ventricular (LV) systolic dysfunction and chronic heart failure (HF), in which favorable clinical outcomes have been demonstrated. However, there is still ongoing controversy regarding the potential role of ivabradine might have on AF. The aim of this study is to evaluate the efficacy of the peri-operative use of bisoprolol and ivabradine versus bisoprolol in the prevention of post-operative atrial fibrillation in patients undergoing elective coronary artery bypass grafting surgery.

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